Is it recommended to have Heller myotomy for recurring achalasia?

Posted on Tue, 16 Jun 2015 in Digestion and Bowels
Question: Hello
I had a Heller Myotomy at 14yrs old, due to sever achlasia. I'm now 50, and having major trouble swallowing. Having to use nitro spray 3 times post meal to pass the food. Had a PD, was symptomatic 3 weeks later. Having a repeat this week.

My question, after so long after the initial Heller, would a repeat be an option, to break up any scar tissue and free the sphincter? I did not have a fundoplication, wasn't done at the time. I'm on Motilium TID and pantaloc.

I also have Chronic pain from arthritis, I do not use anti-inflammatories for obvious reasons. So my pain treatment is only narcotics, which I realize may increase my dysphagia.
Answered by Dr. Muhammad Hanif 2 hours later
Brief Answer:
Achlasia Cardia

Detailed Answer:

You have got Heller's Myotomy done for the issue which has started once again. Yes you are right. It is possible that there are strictures that are formed inside with the passage of time. Also the muscles have got a bit weak in the area. Propulsive peristaltic movements are not going down the tract properly and Achlasia of lower end of esophagus is disturbing the bolus getting down.

Because you are already taking medications that are good for the disease, so I suggest you to please consult the Head and Neck Surgeon or a Gnenral surgeon for proper diagnosis. He may go for Chest XRay and Barrium swallow to look whats going on inside and you may also need esophagoscopy to see if there is an abnormal growth impinging on the way to block food.
Yes narcotics play a little role in dysphagia.

Hope it helps. Please feel free to contact me anytime, if you have any follow up questions or any other health issues.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Muhammad Hanif 2 hours later
I am going for another dilation tomorrow, when they will do an esophagoscopy after. It seems to me the last one didn't last possibly due to scar tissue on the muscle, rather than the mucosa.

Guess I'll find out tomorrow. After 40 yrs of no problem, (mostly) its frustration, and painful when you cant get food to pass. Same with medications.
Answered by Dr. Muhammad Hanif 1 hour later
Brief Answer:
Lets see what comes up in Paeumatic Dilatation

Detailed Answer:
Welcome again,Dear XXXX!

Yes it was due to the Strictures that failed the previous PD on you. I really feel sorry for the situation you are facing right now. For so long time you did well with Myotomy and thats too without fundoplication. But remember every surgical procedure has a limited time span to assist the patient live normal life. For example CABG cardiac surgery after 5-6years leads to blockage in heart vessels again. So please don't feel upset.
Hope you get best out of it tomorrow with PD. And I will wait for results and follow up for the best of your health.

Hope it helps you. If you have any questions/doubts, please feel free anytime to contact me directly on my profile.

Above answer was peer-reviewed by : Dr. Yogesh D
Answered by
Dr. Muhammad Hanif

General & Family Physician

Practicing since :2009

Answered : 2369 Questions


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